Healthcare Provider Details

I. General information

NPI: 1639080278
Provider Name (Legal Business Name): ANDREW DEAN ACERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 O ST
ARCATA CA
95521-5789
US

IV. Provider business mailing address

4139 D ST
EUREKA CA
95503-6442
US

V. Phone/Fax

Practice location:
  • Phone: 707-497-9335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: